Healthcare Provider Details

I. General information

NPI: 1821545708
Provider Name (Legal Business Name): CARLA CEPERO-JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE LUIS MUNOZ MARIN # 5
OROCOVIS PR
00720-4417
US

IV. Provider business mailing address

PO BOX 1859
AIBONITO PR
00705-1859
US

V. Phone/Fax

Practice location:
  • Phone: 787-867-0736
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6070555
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22218
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number22218
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number022218
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: